Art For Patient's Sake
Art for Patient’s Sake
Is the partnership of exhibition galleries with hospitals successful in creating a patient-centric experience?
Arts Organizations in Society
November 30, 2017
Galleries in hospitals are an example of one of the earliest forms of partnership models between arts programs and healthcare facilities that are focused on a patient-centric experience. By establishing such partnerships with healthcare institutions, the arts are an important catalyst for people to regain personal value and in turn reverse the influences of neoliberalism, understood in this context as an economic movement that devalued the public’s stance on healthcare. The gallery model in particular has proven to not only be a sustainable alliance, but also a vital tool of placemaking that allows for community development. This paper examines the benefits and limitations of galleries in hospitals, looking specifically at the Dr. David Flinker Pavilion Art Gallery at Virtua Memorial Hospital in Mount Holly, New Jersey as a case study. The Pavilion Art Gallery began as an exhibition space for local artists to showcase artworks for patients and then later emerged into a public space for community events. As a tool for cultural placemaking, hospital galleries have a tremendous effect in advancing cultural policy by reviving the duality of arts and medicine as a healing practice. The importance of examining the positive and negative outcomes of the gallery and hospital partnership in particular, is a relevant study that promotes recent efforts to reform the US healthcare system through new strategies that include arts programs as a tactic to meet the “patient as a consumer” driven demand for efficient health care.
In a neoliberal turn of events, the United States Healthcare system was accordingly modified with the demise of universal healthcare. This turn not only succeeded on a political level, but also allowed supporters of neoliberalism to execute a persuasive argument against universal healthcare from an economic lens. The public was left with the assumption that universal healthcare is a surplus of government funds, and since then, the healthcare system has been aiming to reform in a political climate that it is continuously affected by. Recent efforts have forced the healthcare industry to reconsider patients as customers in order to reposition the role of the hospital and medical practice as a whole, to meet the demand for more patient-centric healthcare services. New strategies that align with this approach are calling for innovative methods, and the implementation of arts programs has proven to be successful on many levels, making it difficult to deny its ability in achieving a patient-centric experience. Increasingly, more healthcare facilities are looking to establish partnerships with different kinds of arts programs, all of which supplement the healthcare facility to accomplish its mission and goals. These programs emphasize on patient self-evaluation and self-confidence through viewing, experiencing, and making art. Redesigning the hospital environment into gardens, maintaining collections of arts created specifically for patient healing, and developing programs that allow patients to interact with or create their own art are all different models of arts programs in healthcare facilities.
Exhibition galleries are one of the earliest forms of these models and were created and sustained mainly by community members due to insufficient hospital budgets. Art works were placed in impersonal hospital settings and proved to add a calming and stress-reducing environment. Finding an existing space within the hospital to showcase artworks from local artists that patients and staff could purchase allowed for a more affordable way to bring in the arts into a hospital setting, thus creating the notion of exhibition galleries in healthcare facilities. The Virtua Memorial Hospital in Mount Holly, New Jersey was a pioneer hospital to establish and sustain this model by creating the Dr. Flinker Pavilion Gallery in 1980. The gallery exhibits art that aids in the healing process and maintains its mission statement in conjunction with the hospital’s mission statement to create an experience that is patient-centric. However, what has emerged from this arrangement is now an apparatus for creative placemaking in hospitals that may prove to be problematic. The complications that arise from this complex partnership can consequently defy the initial goals and objectives of the hospital and gallery by prioritizing artists who may long for fame and validation for their work over patient needs. The integration of the Dr. Flinker Pavilion Gallery in Virtual Memorial hospital is an example of a successful partnership that leads to cultural policy change, but fall shorts in maintaining a sustainable patient-centric experience.
Neoliberalism and the turn of the United States healthcare system
The neoliberal economic revolution established laws that transformed the US healthcare system through phases that occurred congruently with political and economic events in American history. The Affordable Care Act falls short of establishing universal healthcare and, “should be considered through the lens of key neoliberal economic beliefs.” It is important to understand these beliefs because they restructured not only the entire American healthcare system, but also the mentality of how the public began to view its own self worth. The key beliefs that insinuated the slow closure of the window for universal healthcare include the “moral hazard” of free care, primacy of health consumerism, and the necessity for private health insurance.
The Social Security Act of 1935 was enacted by Franklin Roosevelt who had consciously left universal healthcare out of the plan but later recalled the idea in his 1944 State of the Union Address calling for “the opportunity to achieve and enjoy good health.” After his death, Harry S, Truman re-initiated the campaign for a national insurance program, but was unsuccessful because of resistance from the American Medical Association that accused his administration of communist sympathies. In the midst of Cold War politics, the US moved to an expansion of employer-provided private health insurance and by postwar period, neoliberalism had become a well-funded movement. Its primary thinkers founded key organizations and published works that forged new identity, both politically and ideologically, and heavily nurtured by American capital. In his 1960 The Constitution of Liberty, economist and philosopher, Friedrich Hayek argued, “we all have different preferences for how much healthcare we want in proportion to other ‘material advantages’ in life.” In other words, if our desires for healthcare are not universal then why should we have universal healthcare? This is the root of the neoliberal ideology on healthcare that changed the very notion of healthcare into a commodity, allowing for an individual to have the right to customize their healthcare coverage. The neoliberal undesirability of universal healthcare became part of the mainstream healthcare discourse and such ideas became increasingly dominant in later years.
In 1968, economist Mark Pauly published The Economics of Moral Hazard to construct a case against universal healthcare, arguing the notion of “moral hazard,” or the idea that people would use healthcare unnecessarily just because their insurance made it free. He further argued that there would be a “welfare loss” from this “excess use” as people used care that they didn’t actually value, and in turn generating a surplus of government funds. His argument additionally stated that there would be “utility gain” from buying personalized insurance because, “being insured against uncertainty had some intrinsic value itself, for which it was worth paying.” This value transformation was translated into policy and led to the corporatization of the American healthcare system by convincing people they had to use their own money to buy health care. Cost-sharing programs such as deductibles and co-pays were developed, eventually giving rise to the ideology of the healthcare “consumer” that directly emerged from the “moral hazard” idea. By the 1990s, health insurance was privatized and the power of free market was unleashed with personal tax-deductible health savings accounts, giving people an incentive to spend their money however they pleased. The transformation of the American healthcare system was solidified through neoliberal efforts that convinced society it has buying power and free choice by expressing, “the necessity that capital has to expand by commodifying every aspect of our lives.” Likewise, the baby boomer generation began to view themselves as healthcare consumers and subsequently healthcare facilities reorganized themselves to meet the demands of the “patient as a consumer” ideology.
Why change now? The healthcare reform strategy
In recent years market forces have driven increasing numbers of hospital mergers and acquisitions due to rising costs, lower reimbursement rates, and uneven quality. Healthcare leaders and policy makers have attempted numerous solutions that have had little impact and approaches such as reducing costs, enforcing practice guidelines, trying to make patients better consumers, and implementing electronic medical records, all of which have been proven to be ineffective. The need for a new strategy at this point became a pivotal necessity, requiring the healthcare industry to shift focus from volume and profitability of services provided to patient outcomes achieved by restructuring how healthcare delivery is organized, measured, and reimbursed. A new strategy called, The Value Agenda, was introduced in the book Redefining Health Care and focuses on creating value for the patient by putting patients’ needs first. The tools to implement the value agenda start with establishing the shared goal of improving value for patients for each stakeholder. Value in this context is defined as health outcomes achieved that matter to patients relative to the cost of achieving those outcomes. Either improving one or more outcomes without raising costs or lowering costs without compromising outcomes can achieve improving value.
The results of this shift have proven successful with improvements in outcomes, efficiency, and growth in market share. The challenge for healthcare organizations to increase value of care is a transformation that happens within because, “ultimately value is determined by how medicine is practiced.” The goal of creating value for the patient responds directly to the patient as a consumer driven mentality and positioning the value agenda as a crucial component of medical practice calls for precise execution of the strategy. There are six components of The Value Agenda (see fig. 1) that assist in moving to a high value healthcare delivery system and are all interdependent and mutually reinforcing. The components include, 1. Organize into integrated practice units (IPUs), 2. Measure outcomes and costs for every patient, 3. Move to bundled payments for care cycles, 4. Integrate care delivery across separate facilities, 5. Expand excellent services across geography, and 6. Build an enabling information technology platform. The first two components are necessary to consider for inclusion of arts programs in hospitals.
Integrated practice units are made up of both clinical and nonclinical personnel teams who provide full care for the patient’s condition that results in faster treatment, better outcomes, and lower costs. IPUs often partner with community providers or local organizations to achieve better outcomes, which brings us to the second component of the model, measuring outcomes. The types of outcomes measured include health status achieved, nature of care cycle and recovery, and sustainability of health. Arts Programs fit in effortlessly in these parts of the value agenda model because their primary focus is the patient, and aside from being cost effective, arts programs and organizations help healthcare facilities in achieving their goals from within the hospital delivery system. Arts programs are valuable stakeholders in the strategy for value transformation and must require strong leadership and commitment to improving health outcomes. It is essential to understand why arts programs demonstrate positive outcomes in patient recovery and why they are sought after to implement in the healthcare reform strategy.
Intrinsic value of arts: counteracting the influences of neoliberalism?
The neoliberals convinced us that the insurance benefits once provided to us by universal healthcare are an excess waste of capital. They converted our intrinsic values by giving us freedom to create our own value definitions and pushed for customizable insurance that aligns with our personal care ethics. Reestablishing intrinsic value of wellbeing can be challenging but recent scientific research and evidence has concluded that the arts do play a major role in empowering patients to reevaluate certain aspects of their value system. While the methods of measurement and data collecting are debated and comprehensive, there is no denying that, “the arts actually have a value that goes beyond their intrinsic artistic metric, such as potential to improve public health.” The qualitative over quantitative benefits are more important in this case to determine these answers. Alain de Botton and John Armstrong examine art’s purpose in their book Art as Therapy, stating that art is “a tool that serves an important purpose in our existence.” It allows us to connect to our own psychology and lets us exercise and better understand our emotions. Arts provide self-esteem building, a sense of identity, and belonging by connecting people and celebrating life, facilitating the healing process.
The concept of human wellbeing can be acquired through the arts because the arts have the ability to further non-arts goals. This notion is deeply rooted in the capability approach, which “assumes wellbeing derives from people’s ability to make choices that allow them to lead a life that they have a reason to value.” Indian economist and philosopher Amartya Sen first articulated the capability approach in the 1980s, stating that the capability to live a good life is defined in terms of the set of valuable ‘beings and doings.’ The states of being and doing are analyzed in terms of functionality, such as being well nourished and having shelter, and the collective set of valuable functionings that a person has access to is capability. (see fig. 2). The functioning combinations here do not include the commodities needed to achieve the states of being and doing, and thus, a person’s capability represents the effective freedom of an individual to choose between different functioning combinations that one has reason to value. Therefore, by integrating arts programs into the hospital patient-centric strategy, the arts play a major role in restoring the value of healthcare as a right of entitlement. Arts programs are secretly executing value motives that allow patients to make better choices for their wellbeing and accessible healthcare, these are the very values that were once lost with the commodification of healthcare through neoliberalism in the first place!
Integrating arts programs into healthcare facilities
How exactly do the arts in a hospital setting transform our intrinsic values and help us make independent choices? There are two ways in which patients interact with arts in a hospital setting, first by visual experience or Environmental Arts and second by Participatory Arts. The “aesthetic experience”  of arts is what happens to individuals as they see, hear, and feel art. This experience is created in a hospital setting through visual aspect like architecture and design, gardens, and artwork collections. Participatory arts programs give patients an active engagement in arts creation by allowing them to create their own works, and are more effective compared to environmental art. The creative action of making art gives patients a satisfaction of compiling a finished work along with embedding self-confidence in them. Artists who work with patients in participatory arts should not focus on producing their own work, rather they serve as catalyst for patients’ creativity to make art. This self-esteem building helps patients communicate more openly and allows doctors to reach a diagnosis faster. The role of art is a contributing factor in creating a caring environment of healing that directly correlates with our intrinsic values and has consecutively begun to change the face of healthcare as a business.
Hospitals are more open to incorporating arts programs into their strategy for these reasons and now have the funds to support them internally, mostly thanks to advanced data that has shown an increase in positive outcomes. Aside from their recognizable value, arts programs are easy to implement, they are a cost-effective way to treat, and attract more funding from foundations and corporations for the healthcare facility. Arts programs support six domains of quality in conjunction with The Value Agenda. (see fig. 3). They ensure effectiveness as healing modalities, increase safety by eliminating or reducing use of anesthesia and pharmaceutical drugs, and they exist for patient-centric needs and utilize patient’s own resources for healing. Arts program are also praised for their efficiency to reduce the need for expensive medical personnel, allow procedures to be completed more quickly, and anticipate patient needs in a timely manner. Lastly, they are equitable because art is a universal language that communicates with no boundaries. These six dimensions provide any healthcare organization with a low cost opportunity to improve performance and increase patient value.
As healthcare organizations seek to implement more arts programs in their facilities, arts programs are also establishing concrete business models on their end to ensure partnership longevity. Because of their high demand and efficient implementation, arts programs are easily replaceable, which is why it is important for arts programs to strategize on their end in order to successfully align with the mission and goals of the healthcare facility. A roadmap on how to create an effective and sustainable arts program is provided as a guideline for how the arts program should collaborate with the healthcare organization it is aligned with. (see fig. 4). The principle aspect for a successful partnership for arts programs is detailed under step 2, Develop a Mission Statement and Strategic Goals, where the arts program’s mission and goals have to be in agreement with the mission and goals of the healthcare organization in order to ensure a sustainable and long-term partnership.
Case study: The Dr. Flinker Pavilion Art Gallery and placemaking
One way to incorporate art into a hospital setting is by displaying paintings on the walls of the corridors and lobby. Executed through either exhibition galleries or collection galleries, both models should include paintings that follow a criteria guided through the viewpoint of the patient’s needs in the healing process and the overall mission of the institution and the arts program and “not for art for art’s sake.” Curating a collection gallery requires selecting art that is specifically intended for patient wellbeing and is meant to honor their humanity and recognize them as a whole person, not a person that is diseased or disordered. Themes centering on hope, inspiration, empowerment, recovery, peace, resilience, and celebration that share the mission and values of the hospital supplement the healing environment. Many collection galleries also include artworks created by patients themselves, ultimately making the patient feel included in the hospital community.
Exhibition galleries differ from collection galleries because they provide a continuous renewal and variety of artworks for sale, usually from local artists. The Pavilion Art Gallery in Virtua Memorial Hospital Burlington County in Mount Holly, New Jersey, which was later named The Dr. David Flinker Pavilion Gallery, after its benefactor, was formed in 1980 in a lobby of the hospital for patients, visitors, and hospital staff to come across art daily as part of the hospital experience. The gallery operates as a professional self-contained exhibition space where invitational and juried shows feature works by artists from New Jersey and surrounding states, along with small solo shows by local artists. (see fig. 5). The idea for a hospital gallery began with Bette Johnson, a printmaker and hospital volunteer who taught art to psychiatric patients, and wanted to create a less stressful hospital environment. She partnered up with Pat Stefanini, a painter, and both women presented their research findings to the hospital authorities and pushed to establish an exhibition space in well-trafficked areas of the hospital. Both women were hired as gallery directors, under the public relations department, and initially funded the project through a grant from the New Jersey State Council on the Arts. Johnson and Stefanini claim that the gallery is committed to showcasing and selling only professional art, and have even collaborated with various institutions and local artists to help launch artists’ careers saying, “We are not art agents, but we have helped start some good careers by encouraging artists through their developmental stages.” Along with solo shows and artist openings, the Burlington County Art Guild also utilizes The Pavilion Gallery space to hold its Annual Summer Members’ Exhibit, therefore serving as a community space. The Pavilion Gallery is a multi-functioning gallery space that supports collaboration with community and local artists within the facility, thus creating a powerful tool for placemaking that expresses the hospital’s culture through aspects of a physical environment.
As a community-centric hospital, Virtua Memorial and The Pavilion Gallery share a common mission to improve the lives of the not only the patients but also the community in which they are situated. Collaborating to bring in a visual healing experience for patients warrants the hospital to bring in a diverse group of community members who all take part, one way or another, in cultivating a society that is interlocked in relationships and invested in the wellbeing of its citizens. The exhibit content serves to make patients feel more at home by visually connecting them with their community in a space that encourages creativity through socializing and meets the needs of community activities. Virtua Memorial Hospital plays a vital role in engaging its community in a space devoted to advancing the quality of life that also reflects its values, thus staying incompliance with its mission statement.
The Pavilion Gallery is also a vehicle for new and upcoming local artists to gain high-level visibility, with many artists citing the gallery in their resumes. It also gives artists an advantage in finding meaning to show art that fits into the patient-centric criteria and possibly, “giving a voice and forum to artists who may be outside the mainstream due to physical or medical challenges.” However, because of this artist incentive, the focus can easily turn to the artist’s self-driven claim for fame and away from the patient-centric care as stated by The Value Agenda. If the artist serves as a catalyst for patient’s creativity and the exhibition gallery does not give patients agency to make art, then by denying the act of the creative process of art making itself, the exhibition gallery may in fact be contradictory in its goal to help patients recognize their ability to improve their quality of life and consequently may be turning the attention solely to the artist’s mainstream goals of success. If neoliberalism expresses the need for commodifying every aspect of our lives, then the artists using The Pavilion Gallery as a vehicle to gain visibility cannot escape, “society’s competitiveness and drive for individual achievement.”  While the exhibition gallery model may be an enabler in reversing neoliberal mentality by creating value for people through the visual arts to, it can also easily enable the neoliberal capital desire by providing a space that allows for marketplace incentives. This complication begs to ask the question; at what point is it not about the patient anymore?
In part of being a community center, The Pavilion Gallery is an arts delivery system that is enclosed within the hospital delivery system where staff and patients can purchase works that speak directly to them. This form of community empowerment makes the Virtua Memorial Hospital a cultural institution associated with arts services, which in turn sets a grandiose responsibility on the hospital as a key investor in cultural policy. This could possibly turn the arts delivery system focus towards servicing the public, rather than the creativity and healing of the patient, and consequently go against the initial intent of an arts program, which is based precisely on, “not arts for art’s sake.” Aside from the community benefits of the gallery, these complexities of the exhibition gallery model can easily arise if the hierarchy of patient-centric care and wellbeing outcomes are not the primary concern of all stakeholders involved. It is important to keep patient value a top concern if the institution wants to sustain its mission and goals. If the mission statement is the driving force of the program, then the institution’s provisions for equitable care can easily be built on social equality, providing an agent for cultural policy change.
Cultural policy and change
Considering the role of arts programs in hospital as an advocate for cultural change, Hamilton argues that the arts are proven to be one of the intersectoral interventions important in addressing social and health inequalities and can aim to achieve wider public health objectives, but demand a scientific approach to evaluating the intended health wellbeing outcomes. Data of outcomes achieved is necessary in order to make any further policy decisions and if proven effective, then policy makers will be more receptive to change. What makes The Pavilion Gallery a complex case for policy change is that it falls into a paradox of the spectrum between delivery and creation. Is it a source for creating meaning for the patient or a delivery space for artists’ artworks to be sold as goods? The privatization of the community as a healing support system is an entanglement of discourse between administration and the ongoing privatization of culture the nation is experiencing. Bedoya states, “This privatization is linked to administrating cultural ‘goods’ at the expense of knowing culture as a source of knowledge and meaning.” As exhibition galleries that sell artworks continue to increase in hospitals, the problem then becomes of placing art in a setting that allows it to be confined and reduced to a financial purpose as a product, ultimately going against its potential to redefine personal values that aim to rebuild misconstrued concepts of capitalism. The cultural phenomenon of arts programs in healthcare facilities needs to again, maintain its initial mission by staying focused on its patient-centric goals to make any kind of positive cultural policy change.
Focusing on the positive aspects of The Pavilion Gallery as a nontraditional art institution, it is a link for cultural activity with community development and a type of placemaking that relates to US cultural policy initiatives in many ways. By emphasizing the importance of cross-sector partnerships between arts programs and hospitals and the instrumental value to non-arts stakeholders, “creative placemaking broadens the scope of cultural policy from its conventional focus on funding for non-profit arts and cultural organizations.” While healthcare institutions have included arts programs to make themselves more attractive to patients and funders, they have also become new territory for creative placemaking that is headed in a complete cultural revitalization. The gallery accomplishes what the NEA has named increased community “livability” by improving value and quality of life, greater creative activity, stronger community identity, sense of place, and economic development. Therefore it cannot be denied that the formation of this type of partnership between arts programs and healthcare facilities has some cultural and political will.
Conclusion: reviving the duality of arts and healthcare practice
Healthcare environments continue to become part of the cultural engagement fabric of community by integrating arts programs in the healing process, calling for a whole cultural shift for ways in which medicine is practiced, and the role community has in the healthcare sector. The incorporation of this model in culture can be done through attempting to integrate culture into capability approach, or ensuring a way to create communal value for wellbeing by developing policies that support these aspects of the healthcare sector. Neoliberalism gave us consumer-buying power and how we chose to utilize that power depends on what we as individuals value. The arts play a vital role in establishing confidence that creates value for our own wellbeing and in turn wanting to create a healthcare system available for all fellow community members as we move towards a cultural “we.” It is through art one makes a claim upon society, or cultural citizenship, and art can change or produce progressive public policy.
The incorporation of arts into healthcare facilities starts with their design and efforts need to be made for future planning of hospitals as spaces that manifest a cultural paradigm that combines medicine and community. Creating a cultural policy for this partnership relates to how communities want to imagine spaces that are open to their agency in shaping their personal values. The relationship between arts and hospitals is not something new, rather it is a design that has regenerated from historical relationships between community-focused health care early as the 15th century. The first hospital, which is accredited to the Islamic medieval civilization, called Bīmāristāns, were community wellness centers that took care of the sick, poor, and elderly as part of the charitable care compulsory in Islam and Christianity. Society’s social identity and values were constructed through these charitable bīmāristāns as they were a complex institution of medical care that included gardens, theatres, and libraries as part of their structural design that was literally situated in the nucleus of the city. By incorporating the arts into modern healthcare environments, the revival of this type of medicinal practice gives agency to policy change and formation that encourages not only renovating the design of healthcare facilities, but also calls for collective impact. The healthcare sector has taken a considerable step in incorporating arts programs as part of their strategy in aiming to reform. However, it is suggested to be cautious in turning delivery systems, such as hospital exhibition galleries, into spaces that sell goods in order to avoid the natural commodification that can take place of a service that started with good intentions.
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Figure 1: The Value Agenda
Figure 2: The Capability Approach
Figure 3: Six Domains of Quality
Figure 4: Roadmap to Create Effective and Sustainable Art Programs
Figure 5: Dr. Flinker Pavilion Gallery, Mount Holly, NJ